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States Look to Take on Prior Authorization

The majority of states may act on insurer prior authorization practices in the coming year and even though the year is still only a month old, 16 states are already considering legislation to do so. The desire to act on prior authorization comes as providers continue to express dismay over delays in insurer review of the courses of treatment they seek to initiate for their patients, with some providers maintaining that those delays are jeopardizing the well-being of those patients. Insurers, meanwhile, insist that their reviews are necessary to ensure the health of their patients. In response to such expressed [...]

2023-01-30T06:00:53-05:00January 30, 2023|Uncategorized|

Telehealth Not Improving Opioid Treatment

Telehealth is not improving access to help for patients with opioid use disorders, a new study has found. Instead, use of telehealth is comparable to visits to providers’ offices when it comes to access. According to the analysis, Results of this study revealed that clinical outcomes were similar among patients who were treated by clinicians with high and low telemedicine use during the COVID-19 pandemic, suggesting that telemedicine is a comparable alternative to in-person OUD care. There was no evidence that telemedicine was associated with increased access to or improved quality of OUD treatment. Learn more from the JAMA Network [...]

2023-01-26T06:00:07-05:00January 26, 2023|Telehealth|

Future Financial Prospects Mixed for Post-Acute Providers, Analysis Suggests

Assisted living facilities, hospice, and home health providers should see their profitability rise over the next three years, according to a new analysis by McKinsey & Company. Nursing homes and inpatient rehabilitation facilities, on the other hand, may see their profitability decline as they continue to struggle with the current shortage of qualified nurses. Learn more about the near-term prospects for post-acute-care providers from the McKnight’s Long-Term Living article “Skilled nursing profits will shrink through 2026, even as other post-acute lines gain: analysis.”

2023-01-25T06:00:33-05:00January 25, 2023|post-acute care|

Federal Health Policy Update for January 20

The following is the latest health policy news from the federal government for the week of January 13-20.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has published updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List.  The update adds ten codes to the list of items that require a face-to-face encounter between provider and patient and a written order prior to delivery as a condition of payment.  Go here for a summary of the update [...]

Federal Health Policy Update for January 12

The following is the latest health policy news from the federal government for January 6-12.  Some of the language used below is taken directly from government documents. Renewal of COVID-19 Public Health Emergency Declaration HHS Secretary Xavier Becerra has signed an order extending the previous declaration of a COVID-19 public health emergency.  This declaration extends the emergency to April 11.  The administration continues to assure stakeholders it will provide 60 days’ notice prior to the end of the public health emergency. MedPAC Medicare Rate Recommendations Every year MedPAC recommends to Congress rate increases for the different kinds of health care [...]

Federal Health Policy Update for January 5

The following is the latest health policy news from the federal government for December 23 through January 5.  Some of the language used below is taken directly from government documents. No Surprises Act HHS, the Department of Labor, and the Department of the Treasury have announced increases in the administrative fee for initiating the No Surprises Act’s Independent Dispute Resolution (IDR) process and for certified IDR entities.  Learn more about the administrative fee change here and about the certified IDR entity fee change here.  Both changes took effect on January 1. HHS, the Department of Labor, and the Department of the [...]

Federal Health Policy Update for December 22

The following is the latest health policy news from the federal government for the week of December 19-22.  Some of the language used below is taken directly from government documents. Congress As of this writing, Congress continues to work on an FY 2023 omnibus spending bill:  the Senate has passed it but the House has not yet addressed it.  Highlights of what negotiators have agreed to – but that have not yet been adopted – include: Preventing the additional four percent Medicare sequester for two years. Reducing by more than half the 4.5 percent cut in Medicare payments to physicians [...]

Paxlovid Will Soon Cost Patients

Free Paxlovid treatment for COVID-19 will soon be a thing of the past for many people because in the coming months the federal government plans to stop paying for the drug for everyone who needs it. Nearly six million Americans so far have taken Paxlovid after being diagnosed with COVID, but by the middle of 2023 the federal government is expected to stop footing the bill.  Currently, it pays $530 a dose – a discounted price. When that happens the drug may become far less accessible.  Because Paxlovid is only authorized under federal emergency use authorization, Medicare drug plans are [...]

2022-12-16T06:00:16-05:00December 16, 2022|COVID-19, Medicaid, Medicare|

Federal Health Policy Update for December 15

The following is the latest health policy news from the federal government for the week of December 12-15.  Some of the language used below is taken directly from government documents. White House The White House has unveiled its “COVID-19 Winter Preparedness Plan,” the major components of which are expanding easy access to free COVID-19 testing options in the winter; making vaccinations and treatments readily available as cases rise; preparing personnel and resources; and focusing on protecting the highest-risk Americans.  Learn more about the plan from this White House fact sheet and go here for a transcript of the White House [...]

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The December 2022 MACPAC meeting began with a Commission discussion on two potential recommendations for improving Medicaid race and ethnicity data reporting. As part of its commitment to prioritizing health equity in all of its work, the Commission is focused on how to improve Medicaid race and ethnicity data collection and reporting. In October, staff presented findings from a literature review and key stakeholder interviews, as well as possible approaches for improving the collection [...]

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